1. Reduction of Chest Drain Overuse Through Implementation of a Pleural Drainage Order Set.
- Author
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Tajarernmuang, Pattraporn, Valenti, David, Gonzalez, Anne V., Artho, Giovanni, Tsatoumas, Mary, and Beaudoin, Stéphane
- Subjects
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BODY fluid analysis , *PLEURAL effusions , *MEDICAL protocols , *PATIENT safety , *T-test (Statistics) , *FISHER exact test , *RETROSPECTIVE studies , *HOSPITAL radiological services , *CHEST X rays , *MANN Whitney U Test , *CHI-squared test , *DESCRIPTIVE statistics , *PRE-tests & post-tests , *HEALTH care reform , *MEDICAL drainage , *MEDICAL records , *ACQUISITION of data , *ELECTRONIC health records , *CHEST tubes , *COMPARATIVE studies , *POSTOPERATIVE period , *DATA analysis software , *CHEST paracentesis , *MEDICAL care costs - Abstract
Background and Objectives: Small chest drains are used in many centers as the default drainage strategy for various pleural effusions. This can lead to drain overuse, which may be harmful. This study aimed to reduce chest drain overuse. Methods: We studied consecutive pleural procedures performed in the radiology department before (August 1, 2015, to July 31, 2016) and after intervention (September 1, 2019, to January 31, 2020). Chest drains were deemed indicated or not based on criteria established by a local interdisciplinary work group. The intervention consisted of a pleural drainage order set embedded in electronic medical records. It included indications for chest drain insertion, prespecified drain sizes for each indication, fluid analyses, and postprocedure radiography orders. Overall chest drain use and proportion of nonindicated drains were the outcomes of interest. Results: We reviewed a total of 288 procedures (pre-intervention) and 155 procedures (post-intervention) (thoracentesis and drains). Orderset implementation led to a reduction in drain use (86.5% vs 54.8% of all procedures, P < .001) and reduction in drain insertions in the absence of an indication (from 45.4% to 29.4% of drains, P = .01). The need for repeat procedures did not increase after order-set implementation (22.0% pre vs 17.7% post, P = .40). Complication rates and length of hospital stay did not differ significantly after the intervention. More pleural infections were treated with drain sizes of 12Fr and greater (31 vs 70%, P < .001) after order-set deployment, and direct procedural costs were reduced by 27 CAN$ per procedure. Conclusion: Implementation of a pleural drainage order-set reduced chest drain use, improved procedure selection according to clinical needs, and reduced direct procedural costs. In institutions where small chest drains are used as the default drainage strategy for pleural effusions, this order set can reduce chest drain overuse. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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